Sleep Apnea – Life Insurance Claim Denied
If you have a life insurance claim that was denied for sleep apnea, please contact us to get it overturned and paid. We have done extensive research on this specific health condition and how it relates to life insurance claims. The industry is moving away from even asking about Sleep Apnea on applications because the way it’s determined and treated is almost indefensible by life insurers to treat as a reason to deny a claim.
If your life insurance claim was denied for sleep apnea, we can apply our extensive experience and knowledge to get your denied claim paid.
Call 1-888-428-4868
Most death claims should never be denied for sleep apnea
We’ll discuss later what sleep apnea is. First, let’s discuss how life insurance claims get denied for non-disclosure of Sleep Apnea on the original life insurance application. This is important to understand because difficulty sleeping may or may not be Sleep Apnea and Sleep Apnea is a unique health condition that’s greatly misunderstood by insurers’ claims examiners.
Some life insurance applications ask, ‘have you ever been diagnosed or treated for sleep apnea?’ Others are less clear by asking ‘have you ever been diagnosed or treated for respiratory disorders?’ They make their own assumptions that; 1. an applicant knows that by respiratory disorder, they really mean Sleep Apnea and, 2. that their sleep study concluded their apnea was respiratory-caused. But, in fact, not all sleep apnea is respiratory-based. While it may be, sleep apnea can also be a neurologically-based.
What’s more important for life insurance claims is the cause of the condition and how many apneas actually occurred for the individual during a controlled sleep evaluation. A sleep study measures how many apneas a person has in a sleep session. But, the actual cause of sleep apnea is almost never determined by sleep studies.
Fighting a life insurance claim denial for sleep apnea comes down to knowing how to evaluate the medical records related to the person’s difficulty sleeping, deciphering the sleep study results, and applying the information against life insurance underwriting guides. We’re experts at it.
Types of Sleep Apnea:
Central sleep apnea (CSA) occurs when the brain temporarily fails to signal the muscles responsible for controlling breathing. Unlike obstructive sleep apnea, which can be thought of as a mechanical problem, central sleep apnea is more of a communication problem in the brain, thus neurological.
Obstructive sleep apnea (OSA) is the most common form of sleep apnea and is believed to affect approximately 4% of men and 2% of women. This is a respiratory-based condition.
Mixed sleep apnea is a combination of both obstructive and central sleep apnea symptoms. Some patients being treated for obstructive sleep apnea with the use of CPAP machines develop symptoms of central sleep apnea upon PAP therapy. This phenomenon had long been noticed in sleep labs but had not been previously researched. In 2006 researchers from the Mayo Clinic conducted a study of 223 sleep apnea patients and found that 15% of sleep apnea patients who were believed to have OSA in fact had mixed sleep apnea.
Claim Examinations of Sleep Apnea
Just because someone has had a sleep study and C-pap prescription, but doesn’t mark a “yes” on their life insurance application, isn’t enough to deny a life insurance claim.
There has to be a definitive link between a medical condition and an increased mortality risk. If none exists, then there may have been a misstatement of medical history, but it doesn’t matter because even if the condition was known it wouldn’t have kept the insurance company from offering the policy. It’s a difference between misstatement and a material misstatement – and they’re big differences when it comes to life insurance claims.
The examiner has to look deeper to determine if the insured actually experienced apneas during their study. Then, how many? Then, follow the AHI to determine if the results created an actual risk to the insurance company.
Some insurers have changed their position on sleep apnea to the extreme. Whereas many life insurers used to consider sleep apnea a condition that should be classified as a significant mortality risk, today, many insurers will offer their absolute best ratings to persons with sleep apnea.
Those insurers that still deny claims for sleep apnea have a much higher burden of proof than they used to. Their entire industry is moving away from the long-held practice of denying claims when sleep apnea wasn’t acknowledged on the application for the policy.
Apnea-hypopnea index
This measurement is often presented within the context of a sleep study report. It is the number of times per hour of sleep that your upper airway (tongue or soft palate at throat) partially or completely collapses, leading to a brief arousal or awakening from sleep or a drop in blood oxygen levels. The partial collapse of the airway is called a hypopnea. The complete absence of airflow through the nose and mouth, despite an effort to breathe as measured at the chest and abdomen, is called an apnea event.
The AHI is used to classify the severity of sleep apnea.
This same classification is used to assess how well the CPAP machine is working. The following guidelines are used in adults:
Normal: Fewer than 5 breathing events per hour of sleep
Mild sleep apnea: 5 to 15 breathing events per hour of sleep
Moderate sleep apnea: 15 to 30 breathing events per hour of sleep
Severe sleep apnea: Greater than 30 breathing events per hour of sleep
The infamous C-pap machine:
A CPAP titration study is a type of in-lab sleep study used to calibrate continuous positive airway pressure (CPAP) therapy. CPAP is a common treatment used to manage sleep-related breathing disorders including obstructive sleep apnea, central sleep apnea and hypoventilation and hypoxemia.
Insurers equate the C-pap machine to proof of sleep apnea. If the insured’s medical record says he/she was issued a C-pap prescription, they assume the person must have been treated for sleep apnea. But there are many problems with this assumption.
According to a 2013 Harvard Medical Review article, CPAP and oral appliances work well, but they’re not cures for sleep apnea. The only sure way to rid yourself of the condition for good is to either lose weight or have surgery to remove excess tissue from the palate or throat. Therefore, does the prescription of a C-pap machine equate to a determination of the condition sleep apnea, or is the person’s sleep inhibited by; being overweight, or the shape of their jawline, or the amount of tissue in their soft palate or throat?
Also, many Sleep Study Centers rent and sell C-pap machines. There’s an inherent potential conflict of interest when the professional recommending a specific treatment is also profiting from that treatment. Life insurers may not look past the C-pap prescription as enough proof of having sleep apnea, in their evaluation of a claim.
In fact, most people who are prescribed a C-pap machine stop using it within a few weeks. For those whose sleep improves without the machine, it begs the question, did they ever actually have sleep apnea or was their sleep disturbed by other conditions?
We can tell you from more than 30 years of experience the life insurance claim examiner is not digging-down into this level of information to determine whether the insured who answered “no” to sleep apnea on his/her application, was accurate. If you have a life insurance claim that was denied for sleep apnea, please contact us for a free consultation.
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1-888-428-4868
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